Health Notes ...

Ancient background -- my kidneys failed in 2013 and I was lucky enough to get a kidney transplant from one of my amazing daughters who happened to be a match (Brenna). It's been trucking along doing a wonderful job! Fast forward to 2017 -- I found a small patch of melanoma (stage 1) on my back and got it removed, hoping for no more. That seemed promising, but was not to be. In February 2019, we found not only a recurrence of the melanoma, but also a spot of colon cancer. Excised the melanoma in February, had a colon resection in March, then a neck dissection in May. The colon cancer was stage 1 and was cleanly removed. The neck dissection found a couple malignant lymph nodes, but thirty five of thirty seven nodes were clean! So the summer was spent having no known cancer. Rather a good way to spend a summer!

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Recent background -- for those of you who followed my surgical adventures last spring (or read the ancient background), you know I got to deal with a colon resection for Stage 1 colon cancer and a neck dissection for stage 3 melanoma. The colon cancer seems to have been dealt with. The melanoma decided it wasn't through and a couple spots showed up in early September 2019 (one a little nodule on the surface of my shoulder and another in a lymph node). After biopsies, we ended up going with a form of immunotherapy that has worked well for melanoma, and I've been doing infusions of Pembrolizumab every three weeks since October. I tolerated it fairly well (pumping up your immune system can be tough on your own systems in addition to cancer -- just a bit of colitis though, so not too bad), but the melanoma, unfortunately, has tolerated it as well or even better. Just yesterday, we got the latest scan since September and it it wasn't good.


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So ... met with oncologist this Wednesday morning to go over the radiologist's report on the latest PET scan. We knew it was not good going in, as the goal is to have fewer, smaller bright spots or at least no more or larger spots on the scan. It was a bust in every respect. The ones that were there are larger, and there was somewhere between several and lots of new spots scattered among spine, liver, spleen, lungs, and so forth. My scan was seasonal at least -- lit up like a christmas tree!



My oncologist did say that my brain was so bright it was like looking into the sun. Unfortunately, he wasn't complimenting my intellect -- he was commenting on my brains ability to suck up glucose and the associated dye!

The immunotherapy is not working and something else will be substituted. There is a cocktail of chemotherapy* that has a 25% chance of shrinking things, and a larger chance of stabilizing them. So that appears to be the next, best option.

We had met with a radiation oncologist on Tuesday and made tentative plans for getting the surface nodule of melanoma on my shoulder zapped, but for now, we're going to leave that alone since it remains an easy way to see whether the chemotherapy is working. If it gets to be more of a nuisance, we will revisit the radiation for it.

The good news re. the end of the pembro (immunotherapy) is that the risk to my kidney goes down. The immune system was definitely boosted as it was causing  colitis, but stopping it should make that go away (along with bumping the prednizone for a couple weeks to help). Then the prednizone should go away, which will remove its complications to blood sugar control and etc.

The new chemotherapy is likely to be a bit tougher on some things -- will just have to see how that shakes out, but it seems likely I'll be wearing hats more and shaving less. (I've always hated shaving!)

If the new chemotherapy regimen works, then wonderful. If not, then the prognosis is measured in months to a year (singular) rather than years. OTOH, my father is still alive after being given two to six months to live more than six years ago. And I'm easily as stubborn as he is.

There aren't a whole lot of options left other than this chemotherapy, as clinical trials tend to prefer subjects without a lot of confounding factors (a transplant is a pretty big confounding factor). But we will be keeping eyes open for clinical trials and other options in case the current plan doesn't work out.

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I've always been reasonably good at living in the moment and focusing on the things that seem most meaningful and valuable. The kidney failure was a good chance to get better at that. All the recreational activities surrounding the melanoma, colon cancer, tests, surgeries, and other treatments have been especially good, providing even more practice. So while there are aspects of my current circumstances that suck, I've really been enjoying my life, the things I've been doing, and my friends and family. I have been and continue to be incredibly lucky. There are so many things surrounding me that are absolutely amazing. As I get better and better at recognizing them, I find myself filled with wonder and gratitude.

So -- the biggest take away from this is simply a big thank you. To the whole world, to all my many friends (who are all wonderful and amazing -- please keep that in mind if there are ever times you doubt it!), and especially to my family.

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*The new therapy will be a cocktail of Paclitaxel, Carboplatin, Bevacizumab, and Palonosetron. Surprisingly, since I'm getting this info from the insurance approval, they also approved "unclassified drugs" -- sounds rather like the oncologists can throw anything they like into the soup!